İsmail Ekinözü

Impact of body mass index on left ventricular diastolic dysfunction.

Background: The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function. Methods: The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI] < 25.0 kg/m2), group 2 (BMI 25.0–29.9 kg/m2), group 3 (BMI ≥ 30–39.9 kg/m2), and group 4 (BMI ≥ 40 kg/m2). Results: Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A’ were significantly higher whereas septal E’ and lateral E’ were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P < 0.001). Lateral A’, deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P < 0.001, and P = 0.009, respectively). The E/E’ ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P < 0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P < 0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction. Conclusion: BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus. (Echocardiography 2012;29:647‐651)

Comparison of Changes in Anxiety and Depression Level Between Dabigatran and Warfarin Use in Patients With Atrial Fibrillation

We hypothesized that patients taking warfarin require frequent hospital follow-up and they are at higher risk for complications, so the incidence of depression and anxiety is higher in patients with atrial fibrillation (AF) in the period of taking warfarin compared to the period of taking dabigatran. Fifty patients having AF without valvular diseases under treatment of warfarin in whom a transition to dabigatran was planned were consecutively enrolled in this study and followed up prospectively between July 2013 and July 2014. All patients completed Beck Depression Inventory and Hamilton Anxiety Scale (HAS) at the initiation of study and 6 months after initiation of study. Of the patients enrolled in the study, age, gender, smoking status, and comorbidities were questioned. A total of 50 patients (28 women; mean age 74.6 ± 8.7 years) treated with warfarin in whom a transition to dabigatran was planned were included. Basal mean value of BDS (15.6 ± 7.8 vs 11.5 ± 4.8, P < .001) and HAS (16.8 ± 10.4 vs 12.6 ± 8.1, P < 0.001) was significantly higher in patients when they used warfarin than when they switched to dabigatran. In categorical analysis, frequency of patients with depression (mild, moderate, and severe) was significantly higher in period of warfarin use than after dabigatran transition (n = 24, 48% vs n = 14, 28%, P = .039). Our study demonstrates that patients with nonvalvular AF under treatment of dabigatran had lower BDS and HAS scores compared to warfarin. These findings suggest that dabigatran may increase quality of life and decrease morbidity and mortality due to reduction in anxiety and depression.

The relationship between acute coronary syndrome and sildenafil

Sildenafil is a drug used for male erectile dysfunction. Sildenafils fatal cardiac effects except due to hypotension with simultaneous nitrate use have not been reported.We reported in this case a 70-year-old man admitted to the emergency service with chest pain, which occurs in an hour after sildenafil use. Electrocardiogram showed inferoposterior ST-segment elevation. In angiography, total circumflex artery occlusion has been seen.

High levels of high-sensitivity C-reactive protein and uric acid can predict disease severity in patients with mitral regurgitation

INTRODUCTION Both high-sensitivity CRP (hs-CRP) and uric acid (UA) levels are known to be increased in heart failure patients and are associated with poorer functional capacity and adverse outcome. The role of these markers in patients with mitral regurgitation (MR) is less clear. The aim of this study was to assess the relationship between hs-CRP, UA and organic MR. We also assessed whether hs-CRP and UA levels are correlated with symptoms of MR, severity of MR, LV remodeling and outcome during follow-up. METHODS A total of 200 consecutive patients (87 men [43.5%]; mean age 61.6±12.5 years) with moderate or severe isolated and organic MR were included in the study. All the patients were assessed clinically and were managed and treated with standard medical therapy according to evidence-based practice guidelines. Patients were categorized according to New York Heart Association (NYHA) functional class. We assessed and graded the severity of MR using a multiparametric approach. hs-CRP was measured with chemiluminescent immunometric assay using an IMMULITE® 1000 autoanalyzer (Siemens, Germany). Serum UA levels were analyzed using a Cobas® 6000 autoanalyzer (Roche Diagnostics, Mannheim, Germany). RESULTS Mean UA levels increased significantly with NYHA class: 4.46±1.58 mg/dl for patients in NYHA class I, 5.91±1.69 mg/dl for class II, 6.31±2.16 mg/dl for class III and 8.86±3.17 mg/dl for class IV (p<0.001). Mean UA levels also increased significantly with increased severity of MR (moderate 5.62±1.9 mg/dl, moderate to severe 5.56±1.2 mg/dl, severe 7.38±3.4 mg/dl, p<0.001). There was a significant correlation between UA level and left ventricular end-diastolic diameter (r=0.40; p<0.001), left ventricular end-systolic diameter (r=0.297; p=0.001) and left ventricular ejection fraction (LVEF) (r=0.195, p=0.036), whereas hs-CRP was not correlated with these parameters. In multivariate Cox proportional hazards analysis LVEF, NYHA class and UA levels were the only independent predictors of death. CONCLUSION UA and hs-CRP levels can help identify patients with asymptomatic moderate or severe mitral regurgitation. UA levels may be useful to assess the extent of left ventricular remodeling and in the optimal timing of mitral valve surgery in certain subsets of patients.

Relationship Between Tei Index and PEP-Derived Myocardial Performance Index in Sinus Rhythm.

Abstract The goal of this study was to evaluate the preejection time (PEP)-derived myocardial performance index (MPI) in hypertensive (HT) patients with sinus rhythm and its relationship to the classic Tei index. One hundred five patients were enrolled in the study (65 HT and 40 control subjects). The mean age of all patients was 50.5 ± 15 years and 60% were female. Echocardiography was performed on all patients. MPI was measured with the classic Tei method (MPI-Tei index) and the PEP-derived MPI method by using tissue Doppler echocardiography. Although the MPI-Tei index is defined as the ratio of isovolumetric contraction time (IVCT) along with isovolumetric relaxation time (IVRT) to ejection time (ET), PEP-derived MPI is defined as the ratio of PEP and IVRT to ET. We compared echocardiographic data between the HT group and the control group. MPI-Tei index and the PEP-derived MPI values were higher in the HT group compared with controls (0.52 ± 0.10 vs 0.39 ± 0.07, P < 0.001, and 0.51 ± 0.09 vs 0.39 ± 0.07). PEP-derived MPI was strongly correlated with the MPI-Tei index (r = 0.945, P < 0.001). Our study determined that the PEP-derived MPI might be used in the evaluation of left ventricular function in patients with HT, similar to the classic MPI-Tei index.

Major Adverse Events Rate and Characteristics in Duzce, The Results of Melen Study with 36 Months Prospective Follow-up

Objectıve: Novel studies which investigated extraskeletal effects of vitamin D showed that vitamin D plays important role in whole body health, beyond bone health. Vitamin D receptors are present in various cell types including osteoblasts, cardiomyocytes, myocytes, endothelium, immune cells and neurons. Vitamin D deficiency is defined as 25-hydroxy D3 values 20 ng/ml and its prevalence varies from 27% to 55% in different series. Decline in systolic and diastolic functions of the heart has been reported in patients with vitamin D deficiency.In this study, we aimed to investigate short-term effects of vitamin D treatment on systolic and diastolic functions of the heart in patients with vitamin D deficiency. Methods: Fifty patients (3 male/ 47 female, mean age 46 12 years) diagnosed as having vitamin D deficiency and osteoporosis were included in this study. All patients underwent detailed transthoracic echocardiography for evaluation of left ventricular systolic and diastolic functions of the heart.Oral Vitamin D was administered to all study paitents for 8 days (a total of 300.000 IU). Transthoracic echocardiography was repeated for all patients at 30th days. Results: After one month treatment with oral Vitamin D, serum 25-hydroxy D3 value increased from 11 4 ng/ml to 21 5 ng/ml, p<0.001). After initiation of supplementary vitamin D treatment LVEF (62,6 5% to 63.8 4, p1⁄40.025) indicating LV systolic function improved significantly. Also mitral E/A ratio, a measure of diastolic function, improved significantly after treatment with vitamin D treatment (1.16 0.3 to 1.2 0.3, p1⁄40.028). However, IVCT (95.2 15 to 96 13, p1⁄40.54) and EDEC (197 28 to 197 22, p1⁄40.95) were similar to baseline values. Change in serum level of vitamin D (6Vit D) was correlated with change in LVEF (6EF, r1⁄40.39 and p1⁄40.005) and change in mitral E/A ratio (6E/A, r1⁄40.340 and p1⁄40.016). Linear regression analysis revealed that change in serum 25-hydroxy D3 level (6Vit D) was significantly associated with change in LVEF (6EF) (coefficientb1⁄40.36, p1⁄40.013). Conclusıon: Results of this study show that supplementary vitamin D treatment leads to improvement in LV systolic and diastolic function in patients with vitamin D deficiency, even at short term follow-up. Our results also show that change in Vitamin D level is significantly associated with improvement in LVEF.

ENOXAPARIN INDUCED MASSIVE RECTUS SHEATH HEMATOMA

ABSTRACT Rectus sheath hematoma is an uncommon complication of anticoagulation that generally presents as sudden onset of abdominal pain. Enoxaparin; a widely used low molecular weight heparin in acute coronary syndrome may rarely cause about abdominal wall hematoma. This complication is potentially fatal and needs prompt recognition and treatment. We report here a case of rectus sheath hematoma due to enoxaparin with the diagnosis of acute coronary syndrome. The potential diagnostic and treatment modalities were discussed in the light of the literature. Key words: Rectus hematoma, enoxaparin